Gastrointestinal Disorders and Medication Management

[Pages:9]PNN 231: Pharmacology

Gastrointestinal Disorders and Medication Management

Drugs for the Gastrointestinal Tract Gastrointestinal disorders o Vomiting o Toxic substance ingestion o Diarrhea o Constipation

Treatment for Vomiting Nonpharmacologic measures o What ideas do you have for patients? Nonprescription antiemetics Prescription antiemetics Try to always determine the underlying cause first

Nonprescription Antiemetics Common over the counter (OTC ) o Dimenhydrinate (Dramamine) o Meclizine (Antivert) Use & Considerations o Motion Sickness Take prior to travel Side Effects o Similar to anticholinergics o Drowsiness & Dizziness o What side effects do you expect? o What will you teach? Bismuth subsalicylate o Pepto Bismol Use & Considerations o Nausea, mild vomiting, diarrhea Coats gastric mucosa Acts as an adsorbent to toxins Side Effects o Temporary darkening of stools

Prescription Antiemetics Prescriptive antihistamines o Hydroxyzine (Vistaril) Anticholinergic o Scopolamine (Transderm-Scop)

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Learning Unit 7: Handout

PNN 231: Pharmacology

Learning Unit 7: Handout

Dopamine antagonists o Phenothiazines Prochloperazine (Compazine) Promethazine (Phenergan) o Butyrophenones Droperidol (Inapsine) o MISC Dopamine antagonist Metoclopramide (Reglan)

Benzodiazepines o Lorazepam (Ativan)

Serotonin receptor antagonist o Ondansetron (Zofran)

Nursing Process in Vomiting Assessment o Onset, duration, frequency o Health history o Question Possible factors o S / S infection o Check Vital signs o Bowel sounds o I/O o Electrolytes Interventions o Maintain good oral hygiene o Teach client alcohol intensifies the sedative effect o Teach client no driving / dangerous activities o WARNING: Drugs are not meant for pregnancy related vomiting

Emetic (Induce Vomiting) Activated Charcoal o Promotes adsorption (binding) Use & Considerations o Emergency antidote for treatment of drug overdose or chemical poisonings o Administration = PO, NG o Space 2 h apart from other oral meds o Often used post gastric lavage Side effects o Vomiting & diarrhea

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PNN 231: Pharmacology

Learning Unit 7: Handout

Causes of Diarrhea Foods Impaction Viruses or Bacteria Toxins Drug Reaction Laxative Abuse Traveler's Diarrhea o Escherichia coli Malabsorption Syndrome Bowel Tumor Inflammatory Bowel Disease o Ulcerative Colitis o Chrohn's Disease

Treating Diarrhea Nonpharmacologic measures o What ideas do you have for patients? IV fluid and electrolyte replacement Reduce risk of traveler's diarrhea o Teach... Bottled water Washing fruits Cooking vegetables

Common Antidiarrheals Opiates & Opiate ? related agents o Decrease peristalsis and abdominal cramping diphenoxylate (Lomotil) Combined with atropine loperamide (Imodium) OTC ? traveler's diarrhea Considerations o Monitor for CNS depression o Dependency potential o Contraindicated in liver disease Somatostatin analog o Suppress gastric enzymes o Decreases smooth muscle contraction o Used in severe diarrhea and lower gastrointestinal hemorrhage Octreotide (Sandostatin)

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PNN 231: Pharmacology

Learning Unit 7: Handout

Adsorbents Coats GI tract & binds to toxins

o Kaopectate ? OTC o Pepto Bismol ? OTC

Nursing Process and Diarrhea Assessment o Onset, duration, frequency o Health history o Question Possible factors o S / S infection o Check Vital signs o Bowel sounds o I/O o Electrolytes Interventions o Maintain good skin hygiene and protect from irritation o Promptly report acute abdominal pain and/or bleeding, duration > 48 o Teach client to avoid sedatives and alcohol o Advise client ? take as prescribed Medication can be habit forming Encourage fluids

Constipation Types of laxatives o Osmotic (saline) o Stimulant (contact) o Bulk-forming o Emollient (stool softeners) What are potential causes and nonpharmacologic treatment examples?

Osmotic (Saline) Laxatives Action o Hyperosmolar effect = pulls water into bowel using sodium, magnesium, potassium salts stimulating peristalsis Lactulose (Enulose) Magnesium hydroxide (Milk of Magnesia) Magnesium oxide (Mag-Ox) Sodium biphosphate (Fleet Phospha-Soda) Indication o Diagnostic bowel prep

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PNN 231: Pharmacology

Learning Unit 7: Handout

Side effects o Electrolyte imbalances, hypotension, weakness

Contraindication o Congestive Heart Failure Golytely preferred

Stimulants (Contact) Laxatives Action o Irritant Bisacodyl (Dulcolax) Phenolphthalein (Ex-Lax) Indication o Constipation relief o Adjunct to bowel diagnostic bowel prep Side effects o Nausea, abdominal cramping, weakness, electrolyte imbalance with chronic use, dependency & abuse Contraindication o Intestinal obstruction

Bulk-Forming Laxatives Action o Non-absorbable (fiber) ? causing water absorption promoting bulk and increasing peristalsis Calcium polycarbophil (Fibercon) Indication o Promotes regularity & Increases fiber intake Side effects o Intestinal obstruction with inadequate water intake Contraindication o Intestinal obstruction

Emollients (Stool Softeners) Action o Increase water retention and act as a lubricant Ducosate Sodium (Colace) Pericolace is ducosate sodium with casanthranol Mineral Oil Absorbs fat soluble vitamins! Indication o Prevention, decrease straining, tx chronic constipation

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PNN 231: Pharmacology

Learning Unit 7: Handout

Side effects o Nausea, vomiting, abdominal cramping o Mineral oil absorbs fat soluble vitamins

Contraindication o Inflammatory GI disorders Ulcerative colitis, Chrohn's Appendicitis, Diverticulitis o Bowel obstruction

Nursing Process and Constipation Assessment o Bowel pattern, date of last BM o Health history o Question Possible factors o Check Vital signs o Bowel sounds Interventions o Teach client to report abdominal pain, N/V, rectal bleeding o Teach client that overuse can cause dependency o Teach client to increase fluids and activity as tolerated o Advise client to time administration to avoid disruption of sleep or activities

GERD

Nonpharmacologic Measures Avoid tobacco Avoid alcohol Weight loss Individual intolerances May need to avoid hot, spicy foods Avoid high fat/greasy foods Take NSAIDs, aspirin, & glucocorticoids with food; dose if possible Sit upright Don't eat before bedtime Wear loose-fitting clothing

Pharmacologic Measures Antiulcer drugs o Tranquilizers o Anticholinergic drugs o Antacids o Histamine2 (H2)-blockers

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PNN 231: Pharmacology

Learning Unit 7: Handout

o Proton pump inhibitors o Pepsin inhibitor o Prostaglandin E1 analog

Antacids Action o Neutralize hydrochloric acid Systemic antacids o Sodium bicarbonate = Alka-Seltzer o Calcium carbonate = Tums Non-systemic antacids o Aluminum & magnesium products o Amphojel or Maalox Systemic antacid side effects o Sodium Bicarbonate Hypernatremia & water retention Metabolic alkalosis o Calcium Carbonate Hypercalcemia Milk-alkali syndrome o Both cause rebound acid effect Non-systemic antacid side effects o Diarrhea with magnesium based products o Constipation with aluminum & calcium based products o May contain Simethicone, an anti-gas agent Dosing o 1-3 hours pc & hs o Follow with water o Space antacids 1-2 hours apart from other medications Cautious Use o Electrolyte imbalance o Renal insufficiency related to calcium/magnesium/aluminum o Long term use

H2-Blockers Action o Block gastric cells responsible for secretion of gastric acids Common H2-blockers o cimetidine (Tagamet?) o ranitidine (Zantac?) o famotidine (Pepcid?)

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PNN 231: Pharmacology

Learning Unit 7: Handout

Dosing o Space 1 hour before and 2 hours after antacids

Caution o Renal & Hepatic Disease

BUN, Creatinine, LFT's for All!

Proton Pump Inhibitors (PPIs) Action o Suppress gastric acid secretion by inhibiting the enzyme system in gastric cells blocking final step in acid production Common Use o Tx of GERDS, H. pylori, peptic ulcers, Zollinger-Ellison syndrome

Common Proton Pump Inhibitors Omeprazole (Prilosec) Lansoprazole (Prevacid) Rabeprazole (Aciphex) Pantoprazole (Protonix) Esomeprazole (Nexium)

PPIs

Dosing o Daily Tx with reduced dosing for maintenance/prophylaxsis o Give before food (preferably breakfast)

Cautious use o Hepatic and renal insufficiency

Pepsin Inhibitor Action o Inhibits secretion of pepsin o Coats stomach mucosa Drug = Sucralfate (Carafate) Dosing = 1 gm ac & hs Administer antacids 1-2 hours apart Side effects = constipation

Nursing Interventions for Antiulcer Drugs Evaluate history of discomfort Obtain medication history Assess clients, renal & liver function; baseline stool guiac, and H & H Teach client nonpharmacologic measures, even when medications must be prescribed

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